Plasma concentrations, information and therapy adherence during long-term treatment with antidepressants

The influence of information on drug plasma monitoring during long-term antidepressant therapy in fourteen ambulant, depressed patients was evaluated as variation in the L/D ratio time course. A larger variability in L/D ratio, with higher coefficient of variation and a poorer clinical outcome, was found in non-informed patients. The data support the hypothesis that verbal information on long-term drug monitoring of antidepressants could improve patients' adherence to therapy.

[Radiographic semeiotics of bone metastasis in thyroid carcinoma]

It's well-known that thyroid malignant cancer often metastatizes to skeletal structures. Analysing a wide casuistry of the National Cancer Institute of Milan, we thought right not only consider most common iconographic findings of these bone metastases, but rarest too. Therefore, we studied many radiological symptoms: osteolysis and its shape; extension in the next soft tissues; absence of the periosteal reaction; some resemblances with other primitive cancer or secondary too and dysplasic focus; the changes after therapy usually give a not univocal interpretation of the pictures regarding these peculiar alterations.

Effect of angiotensin-II blockade on systemic and hepatic haemodynamics and on the renin-angiotensin-aldosterone system in cirrhosis with ascites

We have studied the effect of angiotensin-II blockade with saralasin on the cardiovascular and hepatic hemodynamics and on the renin-angiotensin-aldosterone system in fourteen patients with cirrhosis and ascites. Control measurements showed that most of the patients had a low mean arterial pressure, high plasma volume, normal or high cardiac index, low peripheral resistance and high plasma renin activity and aldosterone concentration. The wedged hepatic venous pressure was increased in each patient and the estimated hepatic blood flow was normal in most of them. Overall, saralasin induced a significant reduction of the mean arterial pressure, cardiac index and peripheral resistance. The decrease of the peripheral resistance was greater than that of the cardiac index. Six of the patients developed a marked reduction of the mean arterial pressure with low doses of saralasin (1--2.5 microgram/kg/min), and they had significantly higher plasma renin activity and lower mean arterial pressure than the remaining eight patients who showed a slight or no hypotensive response in spite of infusing saralasin up to a dose of 10 micrograms/kg/min. Overall, the decrease of the mean arterial pressure correlated directly with the baseline values of plasma renin activity. Angiotensin-II blockade induced a significant reduction of the wedged hepatic venous pressure. The hepatic blood flow did not show any significant change. The decrease of the wedged hepatic venous pressure was directly related to the reduction of the mean arterial pressure and also to the control plasma renin activity. Our study indicates that in most patients with cirrhosis, ascites and high plasma renin activity, arterial pressure is maintained by the effect of endogenous angiotensin II on the peripheral vasculature, and we suggest that a pre-existing arterial hypotension secondary to an arteriolar vasodilatation is the cause of renin release in these patients. Our results also show that angiotensin-II blockade is accompanied by a reduction of the post-sinusoidal hepatic vascular resistance.

[Oral gestagen treatment of advanced breast neoplasms with norethisterone acetate]

The medical records of 84 postmenopausal women treated with oral norethisterone acetate (NTA) for advanced breast cancer have been analyzed retrospectively. Treatment was devoid of significant toxicity. 21 patients were not evaluable for treatment response, either due to insufficient data or inadequate tratment trial. Among the 63 evaluable patients, complete plus partial response was obtained in 21 (33.3%) with a median duration of 10 months. Disease stabilization was observed in 16 patients (25.4%) for a median duration of 5 months, while 26 patients (41.3%) showed progressive disease while on treatment. The best response was observed in women with predominantly soft tissue metastases (CR + PR: 34.9%) and aged over 70 (CR + PR: 48%). The literature on norethisterone acetate is reviewed and compared with the present results. The role of progestational agents in the treatment of advanced mammary carcinoma is discussed.

Renin, aldosterone and renal haemodynamics in cirrhosis with ascites

The interrelationships between the renin-angiotensin-aldosterone system, renal haemodynamics and urinary sodium excretion were investigated in fifty-six non-azotaemic cirrhotics with ascites. In twelve additional patients the renal renin secretion rate was also studied. Plasma renin activity and concentration and plasma aldosterone ranged from normal to very high values. There was a significant inverse relationship between plasma aldosterone and the urinary sodium excretion. Plasma aldosterone showed a highly significant direct correlation with plasma renin activity, and plasma renin concentration was closely and directly related to the estimated renin secretion rate. Neither plasma renin activity, plasma renin concnetration nor the estimated renin secretion rate correlated with the renal plasma flow or the glomerular filtration rate. These results suggest that in non-azotaemic cirrhosis with ascites the renin-angiotensin-aldosterone system is an important factor influencing sodium excretion, increased plasma renin and aldosterone concentrations are mainly due to an increased secretion rate, and total renal perfusion is not a major factor influencing renin secretion.

Controlled double-blind trial of camazepam, a new benzodiazepine derivative, versus chlordiazepoxide

31 in-patients with anxiety entered at random in a double-blind clinical trial of chlordiazepoxide and camazepam, a benzodiazepine derivative. They were assessed by three different rating scales. Statistical evaluation of the results showed similar psychopharmacological activity of both drugs. It is concluded that camazepam is suitable for treatment of mild and severe anxiety states.

[Lymphoscintiscanning with colloidal Tc 99m in pediatrics]

Lymphatic scintigraphy has proved a useful addition to radiological lymphography in oncological diagnosis in paediatrics. In cases studied comparatively with the two techniques, scintigraphy has been found to offer good resolution capacity also. The radioisotope method demonstrated its greatest value as a control examination for judging results obtained after surgery or radiation. In doubtful cases it was possibile to repeat the examination after a short time in order to evaluate the development of the lymph node lesion. The technique is easy to carry out in paediatric age: 0.5 ml of colloidal Tc with specific activity from 0.3 to 0.5 mCix are injected subcutaneously, mixed with 75 U of hyaluronidase between the Ist and IInd interdigital space to highlight iliac and para-aortic lymph nodes. The useof 99mTc is of special interest because it has made irradiation of these small patients negligible.

Radiological Study of Complications and Recurrences of Esophageal Carcinoma after Surgery

256 esophageal carcinoma patients subject to various surgical procedures were examined with a view to identifying as early as possible the complications and possible tumoral recurrences, early or late, at anastomosis level. The most caracteristic and frequent radiological features, especially of neoplastic recurrences are presented; the various morphological types are described and discussed and for the first time a radiographic classification is proposed, followed by a discussion of the criteria of differential diagnosis of these lesions, especially from postoperative perivisceritis. Correct identification and precise radiographic description of the early signs of neoplastic recurrence in the esophagogastric anastomoses make it possible to reoperate, at least in some patients.

Psychological and physiopathological study on coronary patients

In this paper the AA have tried to define the relationship between psychopathological characteristics or symptoms and angina attacks in coronary patients. The research plan was agreed upon and carried out as a collaborative program between psychiatrists and internists with the goal of reaching a more comprehensive approach to the psychosomatic patient. In 20 patients suffering from nocturnal angina attacks the polygraphic sleep recording was performed; 10 of them received psychodiagnostic examination (MMPI). In 8 cases during sleep recordings hemodynamic monitoring was also performed. The MMPI data were compared with 82 other individuals who had myocardial infarction (56 ss) and diurnal angina (26 ss) and 34 control subjects without cardiac disease. The results show that the sleep patterns were strongly affected and the most relevant alterations were recorded during the nights with ischemic episodes. No significant correlations were found between ischemic episodes and sleep stages. In no instance did the hemodynamic monitoring show an increase in the parameters related to myocardial oxygen consumption. The psychological data showed that the most severe symptomatology was observed in the nocturnal angina patients where the disease seems to be mostly related to a functional pathogenic mechanism.